Abstract
Background: Until recent recommendations, thrombus aspiration was not routinely recommended for all patients with primary percutaneous coronary intervention.1 However, some small-scale studies or meta-analyses of patients with high thrombus burden have shown that thrombus aspiration is beneficial, or is performed when residual thrombus is present.2 In Vietnam, there has been no study evaluating the thrombus burden in patients with acute ST-segment elevation myocardial infarction (STEMI) or the rate of thrombectomy in STEMI patients undergoing primary percutaneous coronary intervention. This study aimed to evaluate the thrombus burden and the current status of thrombectomy in STEMI patients undergoing primary percutaneous coronary intervention.
Method: Prospective, cross-sectional study. All patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention were included.
Result: 450 STEMI patients, who underwent primary percutaneous coronary intervention, had an average age of 60.98 ± 11.97 years, of which 72.67% were male. Hypertension was the most common cardiovascular disease (57.6%), common coronary risk factors included: Lipid disorders (30.2%), smoking (24.2%), diabetes (20%). There were 139 cases of patients admitted to the hospital within 12 hours of symptom onset (31%), 173 cases admitted after 48 hours of symptom onset (38.4). High thrombus burden (TIMI thrombus grade ≥ 4) was a common condition in STEMI patients in the study with 277 cases accounting for 61.6%. Thrombus Aspiration procedure was performed in 89 (19.78%) patients during intervention, mainly in the group with large thrombus burden (83/89). In the group with large thrombus burden alone, the thrombus aspiration rate was 29.96%. Thrombus aspiration procedure did not increase the rate of cerebral infarction or prolong the procedure time. Post-intervention follow-up showed that the group with large thrombus burden had significantly higher peak Troponin T levels and lower LVEF when compared with the group with small thrombus burden (p < 0.05).
Conclusions: STEMI patients with high thrombus burden (TIMI grade ≥ 4) are a common clinical challenge (61.6%). High thrombus burden is associated with increased peak Troponin T levels after intervention and significantly reduced LVEF compared to the other groups. In the study, the thrombectomy rate was 29.96% in the group with high thrombus burden, and Thrombus aspiration procedure did not increase the rate of cerebral infarction events.